Improving Healthy Food Choices in Low-Income Settings in the United States Using Behavioral Economic-Based Adaptations to Choice Architecture

Abstract

Low diet quality is a significant public health problem in the United States, especially among low-income populations. The food environment influences dietary choices. When applied to eating behavior, behavioral economics (BE) recognizes that decision biases instigated by a food environment saturated with unhealthy foods may lead people to purchase such foods, even when they possess the necessary information and skills to make healthy dietary choices. Choice architecture, a BE concept that involves modifying the appeal or availability of choices to “nudge” people toward a certain choice, retains freedom of choice but makes unhealthy options less convenient or visible. Choice architecture has been demonstrated to influence food choices in various settings, including supermarkets, convenience stores, and food pantries. These modifications are low-cost and feasible to implement, making them a viable strategy to help “nudge” patrons toward healthier choices in food establishments serving low-income populations, including food pantries and retailers accepting the Supplemental Nutrition Assistance Program. This narrative review searched, appraised, and underscored the strengths and limitations of extant research studies that used choice architecture adaptations to influence food choices among low-income populations in the United States. Findings from studies in food pantry settings suggest the potential of BE strategies to improve the healthfulness of food choices and dietary intake in low-income populations. In food retail settings, research suggests that BE strategies increase sales of healthy foods, like fruits and vegetables. We identify new areas of research needed to determine if BE-based modifications in low-income settings have sustained impacts on diet quality.

Online Pilot Grocery Intervention among Rural and Urban Residents Aimed to Improve Purchasing Habits

“…Although the data for all of the food purchases made during this study were not collected, these findings are encouraging when examining innovative strategies to improve food access, nutritional intake, and ultimately the health status of rural and SNAP populations, who generally have disproportional high rates of diet-related chronic diseases, in part due to nutritional inadequacy. Furthermore, previous studies have attempted to target these populations and improve purchasing habits utilizing behavior nudging principles to modify behaviors [ 17 , 29 , 35 ]. However, as online grocery shopping continues to grow as an engagement method, these principles can be applied to an online landscape rather than an in-store approach alone in an effort to improve purchases [ 21 ].…”

“…Several SNAP interventions conducted in grocery stores indicated that shoppers make more nutritious choices when multiple nudges are utilized. Specifically, a systematic review indicated that behavioral economic strategies, such as nudges of easy to understand quick nutrition information, improve purchases of fruits and vegetables [ 17 ]. Several studies using choice architecture constructs, such as changing the store layout and the prominent positioning of healthy foods, improved purchases of healthier foods among those customers [ 5 , 17 , 18 , 19 , 20 ].…”

“…Specifically, a systematic review indicated that behavioral economic strategies, such as nudges of easy to understand quick nutrition information, improve purchases of fruits and vegetables [ 17 ]. Several studies using choice architecture constructs, such as changing the store layout and the prominent positioning of healthy foods, improved purchases of healthier foods among those customers [ 5 , 17 , 18 , 19 , 20 ]. Lastly, a recent study using nudges for online shoppers has indicated that virtual shopping trials using nudges and price incentives improved the purchases of healthy foods for low-income consumers [ 21 ].…”

Importance of Nutrition Security to CVD Prevention Efforts in the USA

“…Several studies have demonstrated that behavioral economics strategies to make healthier food choices more appealing and easier are effective in food banks and pantries. There is evidence that the Supporting Wellness at Pantries (SWAP) traffic-light labeling system [ 79 ] can help food pantry staff procure healthier food options [ 80 ] and that placing healthier foods in more prominent locations (e.g., eye-level) results in healthier consumption [ 81 •].…”

Validating a Nutrition Ranking System for Food Pantries Using the Healthy Eating Index-2015

“…In recent years, charitable food agencies, including both food pantries and food banks, have increasingly devoted efforts to promote healthy food [ 1 , 2 , 29 ]. These efforts include implementing nutrition policies for their food inventory; offering nutrition education programs for their clients; improving the supply of healthy food within the system; and integrating behavioral economic strategies to promote healthy food selection at the food pantry [ 1 , 29 , 30 , 31 , 32 ].…”